Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Nas]

Hi again all,
Can anyone shed some light on why some women bleed on HRT?

Assuming it is NOT caused by fibroids, endo, polyps or cysts. is it that the Oestrogen is stimulating the womb lining, or that the Oestrogen isn’t sufficiently being opposed by the progesterone?

I’m well over 3 years post menopausal.

Did two years on gel and utrogestan, but it didn’t help my symptoms, but zero bleeding ( don’t think I was absorbing).

Been on the 75 patch for 16 months and within 4 months, started to bleed with cramps and pmt etc.

Had a hysteroscopy last April, nothing found and was told to either come off HRT or lower the Oestrogen. Neither were an option and still aren’t.

The 75 suits me well, but the bleeding and pain is getting too much to deal with.

Got another scan on Tuesday.

So, assuming all is well again ( it might not be ) my options are going to be

1. Switch progesterone completely
2. Lower Oestrogen
3 . Increase utrogestan
4. Switch Oestrogen product

Has anyone had any success in simply switching progesterone types or doses to control bleeding?

I’m not keen on the coil.

All this trial and error, plays havoc with my mind and mood.

Any thoughts please?
 

[florriepeck]

Following with interest, as I’m in a similar position. I’m on Evorel 75 patches and two pumps of oestrogel, with 200 mg oral utrogestan daily. At times, I’ve thought that the frequent bleeding has eased, but then it starts again. Currently on my tenth day of quite heavy bleeding and it’s really getting me down: it’s the inconvenience as much as anything, always having to carry sanitary stuff with me. Thought I’d be done with that at nearly 58!
I’ve been under a lot of stress at work lately and I’m wondering if that could have upset hormone balance: I do my best to relieve stress and anxiety with yoga etc.
I’m due to have my next GP review at beginning of March, with Newson clinic, and I’m wondering what my next step should be. I too don’t fancy a Mirena coil but maybe that’s the solution.
I had a hysteroscopy and it was normal.

[Dotty]

Hi I’m in the same position. Just had a hysteroscopy and polyp removal , but don’t know what to do if the bleeding doesn’t stop. X

[Nas]

Thanks both.
It’s really hard to know what to do. Day 4 of cramps and I’m exhausted. I just want this bleed to come, so I can figure out what the hell to do next! I hate it all 😥

[florriepeck]

It’s very wearing, isn’t it? I get aching legs and tiredness and feel anxious. Then the bleeding starts and I think oh yes that’s what that was.

[Nas]

Yes Florrie, it’s awful.

Do you get the cramps too? These are worse than the bleeding for me! I wish I didn’t need HRT as I don’t think I can cope with this bleeding twice a month.
 What do you think your plan will be? I don’t fancy a coil, to me it’s something else to deal with and it seems either brilliant or awful. I can’t risk awful!

[florriepeck]

Not cramps, but bloated.GP has mentioned in the past the possibility of changing to a different progesterone if upping my Utrogestan to 200mg daily didn’t work. I think it was medroxyprogesterone ( Provera) that was the alternative.I don’t like the idea of a coil because of its invasive, permanent nature and because I could still be bleeding.

[Ana21]

Hi Nas!

Another cause of postmeno bleeding on continuous combined MHT is a high progestogen-to-estrogen ratio, ie not enough estrogen.  That was my problem.  I wasn't absorbing the patch. 

I started MHT, Estradot 50 and Prometrium/Utro 100 mg, in Feb 2020.  Bleeding started a few weeks later and continued.  In Sep/Oct 2020, a transvaginal ultrasound and sonohysterogram found no abnormalities.  Biopsy negative.  Endometrium was 1 mm.

Bleeding became heavier and more frequent, every 10-14 days.  Even with my thin endometrium, my doctor didn't consider low estrogen as a possible cause for the bleeding.  He suggested reducing my estrogen or fitting a Mirena.

My symptoms worsened and the bleeding increased.  I frequently had to use a tampon at night.  The constant bleeding made it difficult to treat VVA/GSM.  In Sept 2021, my doctor finally ordered blood tests which confirmed low estrogen.  It was so low, a precise measurement couldn't be provided on the report.  With that info, he concluded the bleeding was due to the progesterone and I was switched to oral estrogen.

Excessive progestogen may produce bleeding from an atrophic endometrium.  It's another cause of postmeno bleeding on continuous combined MHT that isn't discussed much.  Even my doctor didn't consider it for a long time.

Now that I'm on oral estrogen, my bleeding has been steadily lessening, spotting as opposed to bleeding.  Early days.  Hoping it resolves with time.  It's so difficult to find the right balance and this trial-and-error approach to hormone therapy is wearying.  With the continued bleeding, I wonder if something was missed on the scans.  It's such a worry.  I can understand why so many women give up on MHT.  But I'm finally through the worst of the temp side effects of the new regimen and feeling some benefit, so onwards I will go.

Looking forward to hearing how others resolve their bleeding.

[Nas]

Hi Ana,
Yes a thin endometrial lining has been mentioned to me before, from Chelsea and Westminster hospital.

However, my last lining showed 4mm, from 5.3 mm.
Oestrogen was 464, 3 months ago.
If anything, I feel I don’t have enough Oestrogen, but can’t risk increasing, due to the bleeding.

Essentially i need to switch regimes. But with that, comes instability mood wise and frankly, hormonal hell, which I haven’t the energy for.

I am absolutely sure something has gone amiss with the scans.
This is my third one in less than a year and hysteroscopy too, so surely , they should have been able to detect any issues?

Total nightmare comes to mind!

What oral regime are you on now?

I’m pleased to hear things are settling for you.

[Ana21]

Hi Nas!

If you're happy with the Utro, perhaps an increase in dose would resolve the bleeding and cause the least mayhem.

I'm now taking Premarin CEE 1.25 mg and 200 mg Prometrium/Utro (oral) daily.  I'm sleeping well, no hot flushes or night sweats, and I've noticed improvements in libido and responsiveness, so I'll keep going.  No anxiety or mood issues.  If it weren't for the spotting, I'd be doing a happy dance.  Oral estrogen may not be a long-term solution, but I'm enjoying the glimmers of progress so far.  It gives me hope.